Individual
KELLY ROSE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
310107-01
NY
208600000X
Surgery Physician
OT017016
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/22/2016
Last updated
04/23/2022
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